Paul Levy, the blogging CEO of Boston’s Beth Israel Deaconess Medical Center, found himself in hot water last month over an inappropriate relationship with a female subordinate. While some of the details of the transgression remain sketchy, I think I now know enough to opine on it. To my mind, Paul has been an extraordinary healthcare leader, and – while the episode represents a lapse in judgment that deserves censure – he should not lose his job.

Let’s start with some background. Paul took the helm of BIDMC 8 years ago. At the time, the hospital – which operates in the shadow of its more storied Harvard cousins, Brigham and Mass General – was in crisis: its staff was dispirited, it was losing a million dollar a week, and it was still reeling from the challenges of blending the cultures of its two recently merged progenitor hospitals, Beth Israel and Deaconess. (Hint: the religious mismatch was only the start of the tsuris.)

Paul was an unusual choice for the position of CEO. BIDMC CEOs have historically been physician-leaders, whereas Paul’s major prior roles had been to teach Environmental Policy at MIT and to lead the Massachusetts Water Resources Board, where he spearheaded the cleanup of Boston Harbor. Some folks wondered whether he was up to the task of being CEO.

But soon after he began, many skeptics became fans – this was clearly not your father’s hospital CEO. A gifted hands-on manager, Paul gushed with pride over the accomplishments of his physicians, trainees, and nurses; even the housekeepers and transporters. He embraced transparency with bottomless zeal, reporting all of BIDMC’s quality and safety data (good or bad), and challenging fellow hospital CEOs to do the same. He launched a blog, “Running a Hospital,” which became a widely read window into his thinking and management style. Within a few years of assuming his role, Levy had become arguably the best known and most highly respected hospital CEO in the nation.

Sure, it was great theater, but the important thing was that it worked. Last year, I had the honor of being visiting professor at BIDMC, and was struck by the organization’s wonderful people and by their passion for the joint. In the past decade, BIDMC has become a model of innovation, transparency, and collegiality, winning several awards and serving as the subject of a number of case studies regarding hospital quality. When I asked people at BIDMC for their best explanation for the remarkable turnaround, most of them gave the same answer: “Paul Levy.”

There are many examples of Paul’s leadership style and impact, but my favorite happened in 2009, when the economic meltdown pulverized BIDMC’s finances (on top of the usual reasons, some of BIDMC’s key donors had major Madoff issues). Rather than mindlessly triggering scores of demoralizing layoffs, Paul called the entire staff to a meeting in the hospital’s Sherman Auditorium. Kevin Cullen of the Boston Globedescribed the extraordinary scene:

[Paul Levy] looked out into a sea of people and recognized faces: technicians, secretaries, administrators, therapists, nurses, the people who are the heart and soul of any hospital. People who knew that Beth Israel had hired about a quarter of its 8,000 staff over the last six years and that the chances that they could all keep their jobs and benefits in an economy in freefall ranged between slim and none.

“I want to run an idea by you that I think is important, and I’d like to get your reaction to it,” Levy began. “I’d like to do what we can to protect the lower-wage earners – the transporters, the housekeepers, the food service people. A lot of these people work really hard, and I don’t want to put an additional burden on them.

“Now, if we protect these workers, it means the rest of us will have to make a bigger sacrifice,” he continued. “It means that others will have to give up more of their salary or benefits.”

He had barely gotten the words out of his mouth when Sherman Auditorium erupted in applause. Thunderous, heartfelt, sustained applause.

Paul Levy stood there and felt the sheer power of it all rush over him, like a wave. His eyes welled and his throat tightened so much that he didn’t think he could go on.

That, folks, is what I call leadership.

So let’s get to the problem. Last month, the BIDMC board announced that Paul had demonstrated “lapses of judgment in a personal relationship,” leading it to express its disappointment along with its “unanimous continued confidence” in Levy’s leadership. (Well, not exactly unanimous: one board member resigned.) The board also announced that it was fining Levy $50,000, would be considering the matter in setting his salary next year, and had asked state attorney general Martha Coakley (of How’d-You-Lose-Ted-Kennedy’s-Senate-Seat-To-A-Guy-Driving-A-Pickup-Truck? fame) to investigate. Neither the board nor Levy said more, leading to predictable cries of hypocrisy – after all, here was a CEO who branded himself as being all about transparency, invoking “no comment” – and some calls for his resignation.

I’ve wanted to comment on the Levy situation for weeks, but it was difficult to do so without knowing more about the specifics of the “lapse.” Although we still don’t know everything, last week (after obtaining the BIDMC board’s permission) Paul opened up to the media, giving interviews to two Boston newspapers and one TV station.

Apparently, the story is that soon after he became CEO, Paul gave a job to a “very close friend,” a woman who began in an administrative position at BIDMC’s main campus and was later transferred to the hospital’s suburban Needham site. While Paul, who is married, has declined to specify the precise nature of the friendship, it’s clear that it is substantial, and that the woman spent considerable time with the CEO at work. The relationship was well known around BIDMC for years, and several colleagues urged him to either end it or the woman’s BIDMC employment. Finally, earlier this year, she did leave her job at BIDMC, accompanied by a severance package.

Clearly, the optics on this aren’t good and the episode demonstrates a lapse in judgment – both in hiring the woman and in failing to listen to colleagues who asked him to address it. On the other hand, there is no evidence that the woman was unqualified for her role or was paid above market rates (her yearly salary was about $100,000), that the relationship compromised Levy’s performance, or that Levy profited in any way from it.

While the situation calls for criticism, it also begs for perspective. Paul Levy has transformed the quality, safety, and efficiency of patient care at BIDMC, a $1.2 billion organization that cares for hundreds of thousands of patients each year. Moreover, his openness has inspired other healthcare leaders to be more courageous in their approach to safety and quality. In the process of making some hard decisions in a very public job, Paul has amassed some enemies – particularly local unions like the SEIU – who are likely behind more than a few of the vitriolic comments about him that have recently appeared on various Boston-based message boards. That, of course, is their right.

As for me, I’m hoping that the BIDMC board, which showed great courage in hiring Paul Levy and allowing him to make safety, quality, and transparency into signature issues, will show similar courage by retaining him as their leader. He deserves it.

6 Responses to “In Defense of Paul Levy”

I sense that you, Dr. Wachter, share my concern that this episode will silence a very important voice, along with your own and precious few others, speaking out for improvement of patient care processes, patient safety, and better outcomes.
This cannot be allowed to happen. Despite never having obtained an M.D., Mr. Levy is no doubt directly responsible for saving many lives. As you point out, his hospital’s patients, as well as those of others whom he inspires, deserve his continued leadership.

That piece in the Globe is critical of Mr Levy, calling his recent public statements “downright Nixonian in their evasiveness”.

The BIDMC Board had “unanimous continued confidence” in Mr Levy was because one board member resigned in protest to the board’s weak response. There was also a resignation from a member of the extended board.

I too have not seen any “evidence that the woman was unqualified for her role”, but she was hired by Mr. Levy right out of MIT. A couple of short years later, she was made Chief of Staff of another campus hospital even though she did not have an MD (MIT does not grant medical degrees). There has not been any evidence disclosed that she was qualified for her job.

That is witnessed by the last paragraph in the last article you link to :
“I’m curious — at a personal level and as a political scientist — whether one bad mistake in the public eye undoes four decades of public service.’’ Levy said. “And I just don’t know how society, Boston society, will treat that.’’

He thinks it’s not about what he did but about how society reacts. Basically: “It’s not me – it’s them”.

Bob, I am certain there is evidence, if one knows where to find it, that the preferential treatment Levy gave to the woman compromised his performance as a leader and that he ultimately benefited from his action. It can be found in the suffering of staff and in the harm to organizations that occurs when leaders selfishly breach ethical, leadership and organizational principles and standards. It can be found in the tainted decisions leaders make, and in the inappropriate actions they take, considering only their own interests, and not what would be best for the organization. It can be found in organizational cultures who are not just and who do not hold leaders accountable for reckless behavior. It can be found in individuals who may have been more qualified than the woman Levy appointed, and who may not have been given the opportunity to apply for the same position. It can be found in the possible loss to the organization of having a more qualified individual than the woman Levy preferred. It can be found in the woman’s job performance that is stained by her close, personal relationship with Levy. It can be found in the excuses made by others, on behalf of leaders, to justify inappropriate leadership behavior that harms organizations. This evidence challenges us to hold leaders accountable in leading with integrity and in the best interests of their customers, staff and organization.

Sad story. I was regular follower of Paul’s blog but have been too busy to read it on a regular basis the past couple of months. What a shock to read this. Our country needs to funnel money into mental health research so a cure for narcissistic personality can be found for people like Paul, Tiger Woods, Jesse James, etc.

I was barely a toddler at the time, but from what I’ve heard, Nixon didn’t lose his job for signing off on a minor burglary at Watergate. Instead, he lost his job due to the lying and cover-up which followed. The similarity here is that there is apparently quite a bit of deception involved – both of the relationship as it continued, and also now with the fallout. In my humble opinion, relationships and good society in general are based on trust. Deception and lying break trust.

I also realize that none of us are perfect – far from it. But please be careful about jumping to the defence of an ‘inappropriate relationship,’ when in fact there is quite a bit more to it than that.